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Introduction: Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords.Methods: For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021–May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate.Results: A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s)(95% confidence interval [CI] 43.7–56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7–31.0). The median difference between actual and perceived time was 18 s (interquartile range 6–30). We calculated high time distortion as having a difference greater than 30 s between actual and perceived laryngoscopy time. None of the secondary variables had statistically significant associations with high time distortion. Overall, we show that the paramedic’s perception of total laryngoscopy time is significantly underestimated even when accounting for paramedic experience and perceived airway difficulty.Conclusion: This study suggests that time distortion may lead to an unrecognized prolonged procedure time. Limitations include use of a convenience sample, small sample size, and potential uncollected confounding variables.

Background: Procedural sedation and analgesia is an important part of pediatric emergency care, safe and clinically useful alternatives for adequate management are necessary. The objective of this clinical trial was to evaluate the non-inferiority of intranasal dexmedetomidine to nitrous oxide with respect to analgesia for a painful procedure in children 3–15 years of age. Methods: This prospective, equally randomized, open-label, non-inferiority trial was conducted at a Pediatric Emergency Department. Previously healthy children 3–15 years of age, with an extremity fracture or luxation or a burn and requiring procedural sedation and analgesia were eligible. Patients were randomized to receive either intranasal dexmedetomidine or inhaled nitrous oxide. The primary outcome measure was highest pain level during the procedure, assessed with Face, Legs, Activity, Cry, Consolability scale (FLACC). Mann-Whitney U test (continuous variables) and Fisher's test (categorical variables) were used for statistical analysis. Results: The highest FLACC was median 4 (IQR 3–6) with intranasal dexmedetomidine and median 4 (IQR 2–6) with nitrous oxide. The median of the difference between samples from each group for FLACC was 0 with 95%CI (0–1), thus intranasal dexmedetomidine was not inferior to nitrous oxide with respect to the level of pain during the procedure. The same method for procedural sedation and analgesia would be accepted by 52/74 (82.5%) children and 65/74 (91.5%) parents in the intranasal dexmedetomidine group respectively 59/74 (88.1%) versus 70/74 (94.6%) with nitrous oxide. No serious adverse events were reported. Conclusions: The results of this trial support that intranasal dexmedetomidine is not inferior to 50% nitrous oxide in providing analgesia for a painful procedure in children 3–15 years of age and can be considered as an alternative to 50% nitrous oxide for procedural sedation and analgesia. Trial registration: EudraCT 201,600,377,317, April 20, 2017. https://eudract.ema.europa.eu/. [ABSTRACT FROM AUTHOR]

The article explores the peculiarities of harmonizing legislative norms of financial and tax law within the framework of public legal regulation. It is established that the norms of financial and tax law shape the rules for managing the financial system and taxation, contributing to a balance between the state’s needs for financial resources and the preservation of economic stability for citizens and businesses. The demarcation of norms of financial and tax law by the subject of regulation is characterized, emphasizing the common method of legal regulation. It is determined that the norms of financial law regulate budgeting, financial planning, state debt, financial accounting, financial stability, and additional sources of funding. Norms of tax law cover tax rates, tax incentives, tax accounting and reporting, and combating tax evasion. It is noted that due to the common features and subject of legal regulation, conflicts arise between the norms of financial and tax law. It is established that the public legal regulation of conflicts between the norms of financial and tax law involves a systematic and organized process aimed at harmonizing legislative norms and resolving conflicts through the activities of the executive authorities of Ukraine. The competencies of central executive authorities that contribute to the harmonization of norms of financial and tax law are characterized. It is determined that the Cabinet of Ministers of Ukraine, the Ministry of Finance, the State Tax Service, the Ministry of Justice, and the National Bank of Ukraine play a key role in resolving conflicts and coordinating strategies in the financial and tax sectors. It is noted that central executive authorities coordinate and cooperate for systematic conflict management and the achievement of harmony in financial and tax legislation. The efficiency of harmonizing norms of financial and tax law is ensured by creating an Interdepartmental Committee, conducting consultations and discussions, as well as adopting and implementing harmonized subordinate legislative acts. Attention is drawn to the fact that the effectiveness of harmonizing norms of financial and tax law is determined by the efficiency of the procedure for developing harmonized subordinate legislative acts conducted by central executive authorities. [ABSTRACT FROM AUTHOR]

Topical medical therapy is the most common approach to the treatment of many ocular conditions. While effective, topical therapy has numerous important limitations. Eye drops can have unpleasant or even dangerous side effects, are often difficult to self-administer, and the application of multiple drops per day, possibly from multiple different bottles, can be burdensome. Perhaps the most important limitation of topical medical therapy is non-adherence, a complex multifactorial behavior that increases the risk of poor outcomes associated with undertreatment. There is growing interest in a class of therapeutics termed "procedural pharmaceuticals" (PPs), which remove the responsibility of self-dosing from patients. An array of PPs are available for the treatment of a variety of ocular conditions, such as those for glaucoma, retina, and cataract surgery; and many more will emerge in coming years. A paradigm shift away from patient-administered therapy toward provider-administered therapy will have important implications for both providers and patients. This paper explores the impact that PPs have had, and will have, on the clinical practice of ophthalmology. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Babylon Center for Humanities Studies is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Opuntia Brava is the property of Universidad de Ciencias Pedagogicas de Las Tunas, Centro de Documentacion e Informacion Pedagogica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The safe administration of medicine entails a comprehensive set of procedures and protocols aimed at ensuring patients receive the correct medications, in the right doses, via the appropriate route and at the scheduled times. This article, fourth in the series, will outline the safe administration of medicines, including the skills and knowledge required by the healthcare assistant and assistant practitioner to safeguard patients using strategies such as the 9Rs to ensure medication safety. Adverse drug reactions and the importance of managing these effectively are discussed. The final aspect of the article considers the storage of medicines. [ABSTRACT FROM AUTHOR]

The identification of the scope of the limited property law (that is transmission easement), as well as the taking of appropriate actions, has become difficult. The far from sufficient implementation of rules has led to numerous disputes, the resolution of which has been sought in court. Very generalized legal bases, interpretation of regulations and the acceptance of the rulings of common courts have made the development of operating procedures possible and have determined the persons participating in performing work related to transmission easement. The specifics and the multidimensionality of the subject requires cooperation from several experts. The methodological bases are limited, and the regulations unclear. The goal of the research is the standardization of designations of component parts and activities associated with transmission easement. The entire process is made easier by a set procedure proposed in the form of an outline. This study draws attention to individual activities and the order in which they are performed. This allows individual specialists to carry out the next stages of work, which in turn leads to sanctioning the rights of the grantee, while determining fair and satisfactory compensation for the grantor. [ABSTRACT FROM AUTHOR]

A multi‐year review of process safety event learning data revealed that procedure usability and human factors were leading the trends of performance deviations by front‐line personnel. These insights prompted an enterprise‐wide Agile project to build capability focused on effective written guidance using science‐based tools and advanced error reduction techniques. Application of the Agile methodology was critical to gaining stakeholder commitment and establishing a comprehensive procedure integrity lifecycle to drive continuous improvement. Chemours partnered with an external consultant to create a holistic framework applicable to vital process safety roles with an orientation toward operational excellence. We share preliminary learnings and best practices leveraged from the nuclear industry, including systemic drivers to procedural deviations, the "top five error drivers" in written guidance, human performance modes (mental models), and key principles to enable human reliability. [ABSTRACT FROM AUTHOR]

Abstract Background Procedural sedation and analgesia is an important part of pediatric emergency care, safe and clinically useful alternatives for adequate management are necessary. The objective of this clinical trial was to evaluate the non-inferiority of intranasal dexmedetomidine to nitrous oxide with respect to analgesia for a painful procedure in children 3–15 years of age. Methods This prospective, equally randomized, open-label, non-inferiority trial was conducted at a Pediatric Emergency Department. Previously healthy children 3–15 years of age, with an extremity fracture or luxation or a burn and requiring procedural sedation and analgesia were eligible. Patients were randomized to receive either intranasal dexmedetomidine or inhaled nitrous oxide. The primary outcome measure was highest pain level during the procedure, assessed with Face, Legs, Activity, Cry, Consolability scale (FLACC). Mann-Whitney U test (continuous variables) and Fisher’s test (categorical variables) were used for statistical analysis. Results The highest FLACC was median 4 (IQR 3–6) with intranasal dexmedetomidine and median 4 (IQR 2–6) with nitrous oxide. The median of the difference between samples from each group for FLACC was 0 with 95%CI (0–1), thus intranasal dexmedetomidine was not inferior to nitrous oxide with respect to the level of pain during the procedure. The same method for procedural sedation and analgesia would be accepted by 52/74 (82.5%) children and 65/74 (91.5%) parents in the intranasal dexmedetomidine group respectively 59/74 (88.1%) versus 70/74 (94.6%) with nitrous oxide. No serious adverse events were reported. Conclusions The results of this trial support that intranasal dexmedetomidine is not inferior to 50% nitrous oxide in providing analgesia for a painful procedure in children 3–15 years of age and can be considered as an alternative to 50% nitrous oxide for procedural sedation and analgesia. Trial registration EudraCT 201,600,377,317, April 20, 2017. https://eudract.ema.europa.eu/ .

Abstract Topical medical therapy is the most common approach to the treatment of many ocular conditions. While effective, topical therapy has numerous important limitations. Eye drops can have unpleasant or even dangerous side effects, are often difficult to self-administer, and the application of multiple drops per day, possibly from multiple different bottles, can be burdensome. Perhaps the most important limitation of topical medical therapy is non-adherence, a complex multifactorial behavior that increases the risk of poor outcomes associated with undertreatment. There is growing interest in a class of therapeutics termed “procedural pharmaceuticals” (PPs), which remove the responsibility of self-dosing from patients. An array of PPs are available for the treatment of a variety of ocular conditions, such as those for glaucoma, retina, and cataract surgery; and many more will emerge in coming years. A paradigm shift away from patient-administered therapy toward provider-administered therapy will have important implications for both providers and patients. This paper explores the impact that PPs have had, and will have, on the clinical practice of ophthalmology.

Background: Simulation-based training is effective for ultrasound (US)-guided procedures. However, commercially developed simulators are costly. This study aims to evaluate the feasibility of a hand-made phantom for US-guided paracentesis. Methods: We described the recipe to prepare an agar phantom. We collected the US performance data of 50 novices, including 22 postgraduate-year (PGY) residents and 28 undergraduate-year (UGY) students, who used the phantom for training, as well as 12 emergency residents with prior US-guided experience. We obtained the feedback after using the phantom with the Likert 5-point scale. The data were presented with medians and interquartile ranges (IQRs) and analyzed by the Wilcoxon rank sum test. Results: While emergency residents demonstrated superior performance compared to trainees, all trainees exhibited acceptable proficiency (global rating of ≥ 3, 50/50 vs. 12/12, p = 1.000) and comparable needle steadiness [5 (5) vs. 5 (5), p = 0.223]. No significant difference in performance was observed between PGYs [5 (4–5)] and UGYs [5 (4–5), p = 0.825]. No significant differences were observed in terms of image stimulation, puncture texture, needle visualization, drainage simulation, and endurance of the phantom between emergency residents and trainees. However, experienced residents rated puncture texture and draining fluid as "neutral" (3/5 on the Likert scale). The cost of the paracentesis phantom is US$16.00 for at least 30 simulations, reducing it to US$6.00 without a container. Conclusions: The paracentesis phantom proves to be a practical and cost-effective training tool. It enables novices to acquire paracentesis skills, enhances their US proficiency, and boosts their confidence. Nevertheless, further investigation is needed to assess its long-term impact on clinical performance in real patients. Trial registration: NCT04792203 at the ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background: PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot product, demonstrated safety and efficacy in treating complex cutaneous wounds and was investigated for the management of PNS. Methods: A Phase II open-label, pilot, single-arm prospective study was conducted from May 2021 to May 2023 (Ethics Committee approval #7952-20). Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity. Primary healing was assessed at 3, 6, and 12 months. Secondary outcomes included the collection of adverse events. Results: Overall, 51 patients participated in the study. At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively. At 6 months, two PNSs recurred after initial healing and an additional four instances of PNS recurrence observed in 12 months, so a total of recurrence in six patients (11.8%). There were five adverse events (AEs) with no severe adverse events. Conclusion: RD2 Ver.02 is a safe and effective treatment of PNS when coupled with a minimally invasive trephine PNS procedure. Further comparative studies are needed to fully assess the role of this novel therapy for PNS. [ABSTRACT FROM AUTHOR]

This article examines the Egyptian Islamic Supreme Court (al-Maḥkama al-ʿUlyā l-Sharʿiyya), thereafter the isc, and its role in overseeing Islamic judicial practice in the late nineteenth and early twentieth centuries. The isc introduced new procedural requirements for dispensation of justice and assumed the responsibility to defend the jurisdiction of Islamic courts against persistent attempts by British colonial administrators and reform-minded political and bureaucratic elite to limit, if not undermine, their authority. The isc marked the recalibration of the legal and judicial authority of the Chief Judge of Egypt (qāḍī Miṣr, an Ottoman administrative judicial position) along with Shaykh al-Azhar and the Muftī of Egypt (who used to exercise oversight of Islamic courts’ decisions and procedures), in favor of this institutional apparatus. The creation of the isc demonstrates the centrality of the regulatory authority of the Ministry of Justice in fostering any potentiality for Islamic law as a system of governance. The continuous attempts to regulate Islamic courts since the 1880s cannot be examined in isolation from the procedural developments pursued in the secular National and Mixed Courts. The role of the isc was determinative of Islamic judicial practice in lower Islamic courts across Egypt. As a result, operations of Islamic courts were readjusted to a set of evolving norms concerning internal coherence, judicial reasoning, adoption of procedural rules to reflect directives from the Ministry of Justice, and attention to the updated rules of evidence and appeal. This process underscores how Islamic judicial practice was both transformed and made possible through an interwoven set of institutions, actors, and traditions. I argue that this institution, the isc, provides an ideal site for critical and interdisciplinary reflection aimed at exploring both the structural and the contextual history of law in colonial Egypt. [ABSTRACT FROM AUTHOR]

Background/Aim. LeFort colpocleisis (LFC) is a procedure for treating pelvic organ prolapse (POP) in women. The aim of the study was to assess the sociodemographic characteristics, anatomical outcomes, satisfaction, and clinical outcomes of patients who underwent LFC for POP. Methods. The study retrospectively and consecutively included 103 patients who underwent LFC for stage III and stage IV POP between January 2010 and December 2022. The participants' sociodemographic characteristics and clinical outcomes were documented. The Turkish version of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to determine quality of life. Results. The patients' mean a ge was 7 3.1 ± 2 6.7 y ears, mean body mass index 27.4 ± 3.8 kg/m2, parity 4.8 ± 1.5, smoking rate 12.6%, POP quantification (POP-Q) stage III 30.1%, and POP-Q stage IV 69.9%. Their satisfaction rate results were 93.3%. Significant differences were observed in the preoperative period compared to the postoperative period in constipation (40.7% vs. 26.2%; p = 0.038), difficult defecation (22.3% vs. 8.7; p = 0.012), fecal incontinence (18.4% vs. 7.7%; p = 0.039), stress urinary incontinence (25.2% vs. 4.8%; p < 0.001), urge incontinence (49.5% vs. 27.1%, p = 0.001), voiding dysfunction (37.8% vs. 23.3%; p = 0.002), and urinary retention (42.7% vs. 12.6%; p < 0.001). Postoperative PFDI-20 scores were also significantly lower compared to the preoperative period (57.19 ± 16.57 vs. 21.62 ± 6.96; p < 0.001). Conclusion. This study showed that LFC has been established as a surgical procedure with high anatomical success, high patient satisfaction rates, and minimal complications, especially in advanced POP with age-related comorbidities. [ABSTRACT FROM AUTHOR]

Background: Patients often consider bone marrow aspiration and biopsy to be one of the most painful medical procedures. The effectiveness of non‐pharmacological interventions to reduce pain during bone marrow aspiration and biopsy remains unclear. Aim: To synthesize existing evidence regarding the effectiveness of non‐pharmacological interventions in mitigating procedural pain among patients undergoing bone marrow aspiration and biopsy. Design: A systematic review and meta‐analysis of randomized controlled trials. Methods: Six electronic databases, including PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library and Web of Science were searched from inception to July 15, 2023. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 2.0. Meta‐analysis was conducted using STATA 16. The certainty of the evidence was assessed by the GRADE approach. Results: This meta‐analysis included 18 studies derived from 17 articles involving a total of 1017 participants. The pooled results revealed statistically significant pain reduction effects using distraction (SMD: −.845, 95% CI: −1.344 to −.346, p <.001), powered bone marrow biopsy system (SMD: −.266, 95% CI: −.529 to −.003, p =.048), and acupoint stimulation (SMD: −1.016, 95% CI: −1.995 to −.037, p =.042) among patients undergoing bone marrow aspiration and biopsy. However, the pooled results on hypnosis (SMD: −1.228, 95% CI: −4.091 to 1.515, p =.368) showed no significant impact on pain reduction. Additionally, the pooled results for distraction did not demonstrate a significant effect on operative anxiety (MD: −2.942, 95% CI: −7.650 to 1.767, p =.221). Conclusions: Distraction, powered bone marrow biopsy system and acupoint stimulation are effective in reducing pain among patients undergoing bone marrow aspiration and biopsy. Patient or Public Contribution: Not applicable. Relevance to Clinical Practice: This meta‐analysis highlights the effectiveness of distraction, powered bone marrow biopsy system and acupoint stimulation for reducing pain in patients undergoing bone marrow biopsy. Healthcare professionals should consider integrating these interventions into pain management practices for these patients. Registration: (PROSPERO): CRD42023422854. [ABSTRACT FROM AUTHOR]

The statistics on work-related accidents published by the responsible organizations reveal that the average rate of work accidents within the construction sector is more than double that in other industrial sectors. This serious problem has been analyzed by numerous international organizations and institutes dedicated to occupational safety, health and welfare. Therefore, in this article, some results of a research project that aims to reduce workplace accidents through the standardization of safe work processes and procedures in construction sites are summarized. The proposed methodology consisted of the analysis of national and international bibliographies to analyze the different annual variations in the accident rate, allowing a common pattern to be located, as well as its association with the work processes carried out in construction projects to standardize each of the processes which are present in the execution and life phases of the building. It is possible to conclude that the accident rates can be reduced and/or eliminated with the application of each of the processes thanks to the obtained results. [ABSTRACT FROM AUTHOR]

Key points Sham procedures produce a clinically significant impact on patient‐reported outcome measures This effect should be considered when designing and interpreting the results of RCTs [ABSTRACT FROM AUTHOR]

The DMA aims to ensure fairness and contestability in digital markets by imposing ex-ante obligations to designated gatekeepers. Enforcement of the regime was entrusted to the Commission and the procedure mirrors the antitrust regime. However, the designers of the Regulation opted to exclude a role for the Hearing Officer from market investigation proceedings. The Hearing Officer is an independent Commission Official whose main role is to safeguard the undertakings' procedural rights and rights of defence, decide on procedural disputes, and organize oral hearings. Despite some criticisms to the limited extent of their powers, the Hearing Officer fulfils an important role in competition proceedings. Exclusion of their competence from the DMA procedure may result in an increase to the Commission's decisional powers, reduce public trust, lower the quality of the procedure, and deprive it of the valuable oral hearing option. [ABSTRACT FROM AUTHOR]

This review essay discusses two books: Fairness and Rights in International Criminal Procedure by Sophie Rigney and Punishing Atrocities through a Fair Trial by Jonathan Hafetz. It discusses the methods used in each book, their conceptions of fairness, and what they see as the future of fairness in international criminal law. The review argues that when the two books are read together they show how far fairness has come, where it is now, and where fairness is headed in the future. [ABSTRACT FROM AUTHOR]

The scientific article is devoted to the study of the identified vectors of improving the observance of human rights during the application of administrative detention by the police at this stage of the development of Ukrainian statehood. The following vectors for improving the observance of human rights during the application of administrative detention by the police have been identified: the introduction of electronic tools; normative regulation of the procedure for applying administrative detention; improvement of the procedure for appealing administrative detention; normative regulation of the procedure of administrative detention during the establishment of quarantine; legislative consolidation of requirements for the administrative detention protocol. It is proposed to introduce the following electronic tools during administrative detention: electronic digital signature, electronic protocol on administrative detention, entering information about the application of administrative detention to a person in the single portal of state services "Diya". It is emphasized that there is no normative regulation of the procedure for applying administrative detention in case of committing an administrative offense, the subject of which is a legal entity. It is proposed to enshrine the right to challenge administrative detention in Article 261 of the Code of Ukraine on administrative offenses, as well as to additionally duplicate this right in the protocol on administrative detention. Attention is focused on the need to grant the right to an illegally detained person to claim compensation for damages. It is proposed to expand the list of grounds for detaining persons by the police under the conditions of the introduction of quarantine. It is proposed to additionally determine the requirements for protocols in proceedings in cases of administrative offenses in the norms of the Code of Ukraine on administrative offenses. The author notes that the legislation does not provide for additional grounds for administrative detention under martial law, such grounds are general. In addition, it was emphasized that there is no special procedure for administrative detention during martial law. It was concluded that the application of administrative detention, in particular, is a dynamic process that must comply with the principle of legality, the requirements of society's development, standards of compliance with human rights, and other external factors. [ABSTRACT FROM AUTHOR]

This article is the first in a series of articles that aim to provide the healthcare assistant (HCA) and assistant practitioner (AP) with insight regarding the management of medicines (medicines management). Articles in the series will explore the principles of medicine management as they relate to the roles and responsibilities of HCAs and APs. The initial focus of the series centres on the aspects of medicine management that are crucial for the safe administration of medicines, while subsequent articles will explore specific scenarios related to medicine administration, supplemented by a variety of case studies. Articles 1-6 will discuss the principles of medicine management related to the role and function of the HCA and AP. [ABSTRACT FROM AUTHOR]

The scientific problem addressed has a significant importance that resides in the identification and presentation of some essential arguments in this regard: the development of efficient and fair arbitration methods and practices is crucial for maintaining integrity and justice in sports; the existence and regulation of an effective arbitration system can contribute substantially to the quick and fair resolution of disputes in this field, maintaining the stability of the competition and the sports structure; sport has a strong impact on society and the economy, but delayed disputes or with a prolonged resolution period can affect not only athletes and organizations, but also supporters, sponsors and other parties involved (an effective arbitration system can reduce this negative impact); issues related to sports arbitration also represent an opportunity for research and development in the field of law and sport (new approaches can be identified, better practices can be developed and resources can be provided for the continuing education of professionals involved in this field); an effective sports arbitration system can help promote ethical standards and integrity in sports (by ensuring a fair and transparent process, public confidence in the fairness and morality of sporting activities can be strengthened). Therefore, research and scientific approach of the issues related to the advantages of arbitration in the resolution of sports disputes are essential to develop better practices, to maintain the integrity of sport and to ensure a healthy and fair sports environment. [ABSTRACT FROM AUTHOR]

Background: Glucose breath test (GBT) is used for the diagnosis of small intestine bacterial overgrowth. A restrictive diet without fibers and/or fermentable food is recommended on the day before the test. The aim of our retrospective study was to evaluate the impact of two different restrictive diets on the results of GBT. Methods: A change of the pretest restrictive diet was applied in our lab on September 1, 2020. The recommended diet was a fiber‐free diet before this date, and a fiber‐free diet plus restriction of all fermentable food afterward. We thus compared the results of GBT performed before (group A) and after (group B) this pretest diet modification. Demographics, reasons to perform GBT, digestive symptoms, and hydrogen and methane baseline values and variations after glucose ingestion were compared between the two groups. Key Results: 269 patients underwent GBT in group A, and 316 patients in group B. The two groups were comparable in terms of demographics. Methane and hydrogen baseline values were significantly higher in group A (respectively 14 [18] vs. 8 [14] ppm, p < 0.01 and 11 [14] vs. 6 [8] ppm, p < 0.01). The percentage of positive tests was higher in group A for methane (43% vs. 28%, p < 0.05), and for hydrogen (18% vs. 12%, p = 0.03). Conclusion & Inferences: This retrospective study suggests the importance of the restrictive diet prior to GBT. A strict limitation of fibers and fermentable food decreased hydrogen and methane baseline values, and the prevalence of positive GBT. Thus a strict restrictive diet should be recommended on the day before the test, in order to limit the impact of food on hydrogen and methane breath levels, and possibly improve the diagnosis quality of GBT. [ABSTRACT FROM AUTHOR]

Thoracentesis is one of the most important invasive procedures in the clinical setting. Particularly, thoracentesis can be relevant in the evaluation of a new diagnosed pleural effusion, thus allowing for the collection of pleural fluid so that laboratory tests essential to establish a diagnosis can be performed. Furthermore, thoracentesis is a maneuver that can have therapeutic and palliative purposes. Historically, the procedure was performed based on a physical examination. In recent years, the role of ultrasound has been established as a valuable tool for assistance and guidance in the thoracentesis procedure. The use of ultrasound increases success rates and significantly reduces complications. The aim of this educational review is to provide a detailed and sequential examination of the procedure, focusing on the two main modalities, the ultrasound-assisted and ultrasound-guided form. [ABSTRACT FROM AUTHOR]

Anxiety is a common problem in patients scheduled for a procedure, and their level of anxiety increases as the procedure date approaches; pre-procedural anxiety is observed in hepatocellular carcinoma (HCC) patients scheduled for liver ablation treatment. There is currently a lack of standardized education provided to patients about liver ablation treatment, which may contribute to patients' anxiety. To test the effectiveness of a pre-procedural video educational tool to reduce patient anxiety and increase knowledge in HCC patients in an interventional radiology clinic setting. This was a quasi-experimental, single-arm study, with a pre-test/post-test. Participant recruitment was based on a convenience sample. Inclusion criteria included: patients ages 18 and older; have biopsy-proven HCC or have a liver mass suspicious for HCC based on LI-RADS criteria imaging; no prior liver ablation treatment within three months of study onset. Participants watched a 7:04 minutes video and completed a 40-item State-Trait Anxiety Inventory and 10-item Knowledge Questionnaire before and after the video intervention to assess changes in anxiety and knowledge. Demographic variables evaluated included age, gender, education, and primary language. There were 16 participants who met inclusion criteria. The state anxiety scores were significantly lower after the intervention (Md = 33.50, n = 16) compared to before (Md = 47.50, n = 16), z = −2.67, p =.009, with a medium effect size, r = 0.47. The trait anxiety scores did not show sufficient evidence for a difference after the intervention (Md = 40.00, n = 16) compared to before (Md = 39.50, n = 16), z = 0.71, p =.50, with a small effect size, r = 0.13. The knowledge scores were significantly higher after the intervention (Md = 9.00, n = 16) compared to before (Md = 2.00, n = 16), z = −3.53, p =.0005, with a large effect size, r = 0.62. A nonparametric bootstrap and nonparametric permutation test also showed evidence for a difference in mean between the distributions of the state anxiety and knowledge pre- and post-intervention scores. The results of this study showed evidence for the effectiveness of video education in decreasing anxiety and increasing knowledge in HCC patients. A standardized pre-procedural video educational tool can be a useful practice across all interventional radiology departments as it is associated with improved quality of care and positive health outcomes. • Surgical procedures can cause anxiety in cancer patients. • Preprocedural video education in liver cancer patients decreases anxiety. • Early video education increases patient knowledge. [ABSTRACT FROM AUTHOR]

An unpredictable emergency situation might happen due to the adverse reaction to psychoactive drug plus physiological disease problems. When a first aid incident occurs, psychiatry nurses who are inexperienced and lack confidence might have impared judgements and inefficient division of labor, which can contribute to an issue of first aid. The current analysis confirmed that task assignment is not specific, a lack of recognition of the accurate position of the first aid cart materials and standard operation procedure, and that the education training is deficient. Moreover, the restrictions of the first aid environment is also related to first aid results. This project defined the division of task assignment, developed first aid cart material pairing software, revised standard operation procedure, and conducted first aid simulation training classes. Results indicated a rise in the accuracy of first aid procedure from 63.7% to 95.6%, and the first aid procedure cognition rose from 64.89% to 92.12%. Additionally, the project increased the awareness of first aid procedure, self-confidence, and brought the team together to reduce the misstep of first aid procedure. [ABSTRACT FROM AUTHOR]

The introduction of the Digital Markets Act (the 'DMA') marked the beginning of a new regulatory framework for limiting the impact of strong platforms in digital markets. With the aim of ensuring fairness and contestability in digital markets, the new Regulation provided for a detailed administrative process, in the form of market investigations, for determining which of the digital platforms act as gatekeepers in their respective markets, whether the designated gatekeepers comply with their obligations, and to what extent new obligations must be introduced to account for new developments. This article discusses some preliminary issues related to the European Commission's administrative procedure for enforcing the new regulation. Upon summarizing the key elements of the DMA procedure, it focuses on four issues: the relationship between the DMA and competition law and problems regarding their parallel application; the obligation for recording interviews conducted for the purposes of gathering information regarding the subject matter of a market investigation; access to file limitations; and the absence of provisions regarding private enforcement and the possibility for third parties to claim damages. [ABSTRACT FROM AUTHOR]

This paper aims to present effective methods for teaching exercises during physical education and sports lessons by performing exercises in pairs. The presence of a partner and/or opponent not only adds a competitive element but also simulates adaptation to unpredictable changes, thus creating conditions similar to those encountered in a real basketball game and providing more realistic feedback on the applicability of technical procedures in basketball. Materials and Methods: The subjects included in the study were represented by two fifth-grade classes (one experimental class and one control class) from “Ion Agârbiceanu” Secondary School in Cluj-Napoca. Initial tests were applied to both groups involved in the research, then the experimental group was subjected to a variety of pair exercises, followed by the same tests being applied to both groups again at the end. Results: The results obtained from the two tests applied to both groups in the research show a more visible progress in the experimental group, especially in the second test, where a very large difference can be seen. In the experimental group, 18 out of 20 students improved their shooting percentage, while in the control group, only 5 achieved this. Conclusions: Based on the results obtained, we can confidently state that applying pair-specific basketball exercises improved the execution of procedures and technical elements.

This paper investigates the procedure for determining the new Hijri Month between Brunei, Indonesia, Malaysia, and Singapore. It endeavours to understand the reason for dissimilarity in terms of practice between these four nations in commencing Hijri Month of Ramadan, Shawal, and Zulhijjah despite sharing the same lunar crescent visibility criterion. This study is conducted through the examination of literature with regards to regulations of the lunar crescent visibility criterion between these countries. The study finds out that the determination of the Hijri months, particularly Ramadan, Shawal, and Zulhijjah, varies among Malaysia, Indonesia, Brunei, and Singapore despite their shared criteria for the rest of the lunar calendar. Brunei relies on moon sightings coordinated by the Chief Syar'ie Judge and various governmental departments, culminating in approval by the Sultan. Indonesia conducts a comprehensive Sidang Isbat conference involving numerous religious and scientific bodies, with the final decision made by the Ministry of Religious Affairs. Malaysia's process involves Department of Islamic Development Malaysia (JAKIM) and multiple expert panels, with the final announcement made by the Keeper of the Ruler's Seal after royal consent. Singapore employs purely astronomical calculations using Unofficial Meeting of Religious Affairs Ministers of Brunei, Indonesia, Malaysia and Singapore (MABIMS) criteria without moon sightings due to environmental constraints. These countries' methods reflect their unique institutional, cultural, and religious contexts. Factors influencing these differences include reference points for lunar calculations, the principles of Islamic jurisprudence, and public comprehension. Indonesia's diverse demographic and significant influence from Muhammadiyah and Nahdlatul Ulama groups lead to varied practices. Malaysia experiences minimal impact from smaller groups but historically had a notable discrepancy in Ramadan 1983. Brunei's unified adherence to the Shafi'i School of Thought ensures consistency in moon sighting practices. Singapore's reliance on calculations is driven by its inability to perform moon sightings due to light and industrial pollution. The study concludes that while MABIMS countries aim for a unified lunar crescent visibility criterion, practical implementations remain distinct, leading to potential differences in the start of important Hijri months. The need for a unified reference point and further discussions among MABIMS officials is highlighted to achieve consistent Hijri month determinations.

The relevance of environmental justice in global biodiversity and climate governance has increased as stakeholders’ unequal affectedness by environmental action is becoming ever more obvious. International Cooperative Initiatives (ICIs) play an ever increasing role in addressing global environmental change and biodiversity loss. Yet, the consideration of demands of environmental justice by these non-state or hybrid actors is still under-explored. Informed by a three-pillar environmental justice framework comprising distributive, procedural, and recognition justice, we use content analysis to identify if and how these different pillars are presented on the websites and in the key publications of a sample of 53 ICIs. A majority of these ICIs include references to environmental justice and its different pillars in their description of their work. But environmental justice seems to be neither a central concern nor are the references very nuanced. Distributive justice receives the most attention, whereas aspects of procedural and recognition justice receive less attention. To better anchor environmental justice within global biodiversity and climate governance, we encourage ICIs to thoroughly integrate environmental justice in operational work and to integrate and establish ongoing dialogues with marginalised groups.

The Effects of Endotracheal Suctioning and Invasive Interventions on Hemodynamic Parameters and Pain Behaviors in Adult Intensive Care Patients: Observational Study University

Introduction: We have observed inconsistencies in residents’experiences regarding important procedures and tasks necessary for patient care. We aimed to improve individual motivation tolearn and become facile with specific practices earlier in the timeline of the internship years.Methods: Intern Bingo was implemented in a single general surgery residency. Two sites, both tertiary care centers with institutional practices, were utilized. Twenty-four procedures/tasks important to clinical practice were identified, including but not limited to Nasogastric Tube placement, IV insertion, incision and drainage, laceration repair, vascular doppler exam, andclinical documentation. Bingo cards were randomly generated. To assess comprehension, interns taught back necessary components to a senior resident or attending to complete each bingo square; including indications, supplies, steps, troubleshooting techniques, and complications. First, the residents were awarded prizes to complete a row and a full card (a cloth scrub cap and portable pulse-oximeter, respectively). A Likert-scale survey assessing satisfaction was administered following the completion of the internship period.Results: The first row was completed in two weeks and the first full card at four weeks. All participants finished the cards within 8 weeks. 54% of the participants returned the survey and100% reported positive experiences. 50% felt that bingo created a healthy learning environment with improved teaching, and the remaining 50% were neutral. 75% reported that Bingo positivelyinfluenced decisions to seek out opportunities. 100% conveyed a desire to repeat Bingo as mentors. Feedback from the attendings was gathered, with positive assessments of the interns’ skills and confidence.Conclusion: Bingo is a simple and easily implemented educational tool that works to alleviate variations in experience early in the internship period. It represents a novel and effective way tomotivate the interns to learn important procedures and tasks within the first two months of residency. Cards may be effortlessly tailored to a variety of residency programs and rotations.

Right to action as a natural right recognized in Constitution an International Pacts. Except some rare cases, everybody is free to act with this right. The conflict is a pre se requisite of litigation but we see some cases by the subject of homologation a contract which has not yet a conflict and courts have not a similar jurisprudence in cases. Although courts can, qualification or requalification the title of litigation but the manner is civil cases is different and the courts can see the cases, which permitted by laws and regulations exceptionally. We think that a litigant has profit to litigate and so we are trying to critic the case law and courts can, qualification or requalification the title of litigation but the manner is civil cases is different and the courts can see the cases, which permitted by laws and regulations exceptionally. So as a result, every conflict by a legal consequence will be accepted as litigation.

Abstract Background Simulation-based training is effective for ultrasound (US)-guided procedures. However, commercially developed simulators are costly. This study aims to evaluate the feasibility of a hand-made phantom for US-guided paracentesis. Methods We described the recipe to prepare an agar phantom. We collected the US performance data of 50 novices, including 22 postgraduate-year (PGY) residents and 28 undergraduate-year (UGY) students, who used the phantom for training, as well as 12 emergency residents with prior US-guided experience. We obtained the feedback after using the phantom with the Likert 5-point scale. The data were presented with medians and interquartile ranges (IQRs) and analyzed by the Wilcoxon rank sum test. Results While emergency residents demonstrated superior performance compared to trainees, all trainees exhibited acceptable proficiency (global rating of ≥ 3, 50/50 vs. 12/12, p = 1.000) and comparable needle steadiness [5 (5) vs. 5 (5), p = 0.223]. No significant difference in performance was observed between PGYs [5 (4–5)] and UGYs [5 (4–5), p = 0.825]. No significant differences were observed in terms of image stimulation, puncture texture, needle visualization, drainage simulation, and endurance of the phantom between emergency residents and trainees. However, experienced residents rated puncture texture and draining fluid as “neutral” (3/5 on the Likert scale). The cost of the paracentesis phantom is US$16.00 for at least 30 simulations, reducing it to US$6.00 without a container. Conclusions The paracentesis phantom proves to be a practical and cost-effective training tool. It enables novices to acquire paracentesis skills, enhances their US proficiency, and boosts their confidence. Nevertheless, further investigation is needed to assess its long-term impact on clinical performance in real patients. Trial registration NCT04792203 at the ClinicalTrials.gov.

Abstract Background Procedural sedation and analgesia are commonly used in the Emergency Departments. Despite this common need, there is still a lack of options for adequate and safe analgesia and sedation in children. The objective of this study was to evaluate whether intranasal dexmedetomidine could provide more effective analgesia and sedation during a procedure than intranasal esketamine. Methods This was a double-blind equally randomized (1:1) superiority trial of 30 children aged 1–3 years presenting to the Emergency Department with a laceration or a burn and requiring procedural sedation and analgesia. Patients were randomized to receive 2.0 mcg/kg intranasal dexmedetomidine or 1.0 mg/kg intranasal esketamine. The primary outcome measure was highest pain (assessed using Face, Legs, Activity, Cry, Consolability scale (FLACC)) during the procedure. Secondary outcomes were sedation depth, parents’ satisfaction, and physician’s assessment. Comparisons were done using Mann–Whitney U test (continuous variables) and Fisher’s test (categorical variables). Results Adequate analgesia and sedation were reached in 28/30 patients. The estimated sample size was not reached due to changes in treatment of minor injuries and logistical reasons. The median (IQR) of highest FLACC was 1 (0–3) with intranasal dexmedetomidine and 5 (2–6.75) with intranasal esketamine, (p-value 0.09). 85.7% of the parents with children treated with intranasal dexmedetomidine were “very satisfied” with the procedure and sedation compared to the 46.2% of those with intranasal esketamine, (p-value 0.1). No severe adverse events were reported during this trial. Conclusions This study was underpowered and did not show any difference between intranasal dexmedetomidine and intranasal esketamine for procedural sedation and analgesia in young children. However, the results support that intranasal dexmedetomidine could provide effective analgesia and sedation during procedures in young children aged 1–3 years with minor injuries. Trial registration: Eudra-CT 2017-00057-40, April 20, 2017. https://eudract.ema.europa.eu/

Background: Access to catheter ablation for atrial fibrillation (AF) may vary due to social deprivation. Objectives: This study sought to characterize the correlation between our outcomes of interest (rates of AF diagnoses, ablation referrals, and procedures) and the association between social deprivation and our outcomes. Methods: Rates and correlations of AF diagnoses, ablation referrals, and procedures were reported across 49 census divisions in Ontario, Canada. We used the Ontario Marginalization Index to determine the relationship between dependency, material deprivation, ethnic concentration, and residential instability and our outcomes. Results: Between April 2016 and March 2020, there were 146,366 patients diagnosed with AF; 6,506 patients were referred for ablation; and 4,673 patients underwent de novo ablation. The median age was 72 years (IQR: 61-81 years; 45% female) for the AF cohort and 62 years (IQR: 55-69 years, 33% to 34% female) for the referral and procedure cohorts. There was geographic variation and a weak concordance between AF diagnoses, ablation referrals, and procedures (correlation coefficients 0.33-0.36). Increased material deprivation was associated with more AF diagnoses (rate ratio [RR]: 1.13), but fewer ablation referrals (RR: 0.49) and procedures (RR: 0.48). Increased residential instability was associated with more AF diagnoses (RR: 1.02), but fewer ablation referrals (RR: 0.63) and procedures (RR: 0.64). Higher ethnic concentration was associated with fewer AF diagnoses, ablation referrals, and procedures. Conclusions: In a jurisdiction with universal health care, greater material deprivation and residential instability were associated with more AF diagnoses but less access to ablation, suggesting substantial social gradients in equitable access to AF care.

Rembang Regency is located on the north coast of Java Island, Central Java Province, Indonesia, which has many beaches ideal for tourism activities. Even though it has the charm of beaches, natural tourist destinations are still the primary choice compared to cultural and artificial sites. However, limited studies exist regarding standard indicators for assessing natural tourism potential in Rembang Regency, which is essential for identifying potential tourist locations. This research focuses on grouping indicators of natural tourism potential based on six main aspects: attractions, amenities, accommodation, activity, accessibility, and ancillary services, environment in tourist areas, and human resources considerations. A taxonomic model will be utilized to develop a procedure for determining natural tourism potential, including indicator weighing via a hierarchical analysis. The findings will yield a taxonomy model aiding information and knowledge management, fostering information sharing and utilization. Moreover, the established procedures will facilitate an accurate and efficient determination of natural tourism potential. This research aims to contribute to sustainable natural tourism management in Rembang Regency, preserving nature while enhancing the tourist experience. [ABSTRACT FROM AUTHOR]

The context in which the tourism sector is developing in Cuba has been conditioned by a dizzying decline in income, largely associated with the spread of the SARS-CoV-2 virus and the post-pandemic effects of Covid-19. This behavior has brought with it the search for alternatives that would bring about imminent solutions. The need to assume new patterns to reach again the competitive position before the pandemic is a challenge for Cuba, which demands transforming changes from science. The objective of this work is to propose a procedure for the design of indicators to determine the competitiveness of the tourist destination Santiago de Cuba. For this purpose, a procedure based on multivariate analysis is proposed, which is carried out through a scientometric study that validates the main sources that support the competitiveness of destinations, as well as its dimensions and pillars. Documentary, statistical and exploratory analysis is also carried out. As main results, three dimensions are obtained, which are disaggregated into five pillars for which eight general indicators are defined. In this sense, it is concluded that the destination is competitive; however, strategies must be designed to guarantee consumer loyalty and attract new segments. [ABSTRACT FROM AUTHOR]